Discipline of Ophthalmology and Visual Sciences, University of Adelaide, South Australia.
Ophthalmology. 2010 Nov;117(11):2222-8. doi: 10.1016/j.ophtha.2010.02.013. Epub 2010 Jun 8.
To describe a case series of patients with anterior orbital invasion by medial canthal basal cell carcinoma (BCC) managed with non-exenterating surgery.
International, multicenter, retrospective, noncomparative, consecutive case series.
Twenty patients identified from the individual institutions' databases with histologically confirmed orbital invasion by periocular BCC.
Examination of charts, relevant imaging, and histopathologic data.
Demographics; clinical characteristics and radiologic features; histopathologic features; surgical techniques for excision, reconstruction, and subsequent procedures; complications; visual acuity; and recurrence.
Twenty patients were identified. Twelve of 20 patients (60%) had recurrent BCCs, with 1 patient having had prior radiotherapy for previously incomplete excision. Eighteen of 20 patients (90%) had a palpable mass, 16 of 20 patients (80%) had clinical involvement of the nasolacrimal system, and 1 of 20 patients (5%) had limited extraocular movements. Preoperative radiologic evidence of orbital invasion was found in 10 of 20 patients (50%). Histologic evidence of orbital invasion was present in every patient, the subtypes being infiltrative (9/20, 45%), nodular (4/20, 20%), micronodular (2/20, 10%), multifocal (1/20, 5%), and mixed (4/20, 20%); extratumoral perineural invasion was present in 1 patient (5%). Final margins were clear in 18 of 20 patients (90%), positive in 1 of 20 patients (5%), and unclear in 1 of 20 patients (5%). Reconstruction was by direct closure in 1 patient and by a variety of standard oculoplastic flaps and grafts in 19 of 20 patients (95%). Twelve of 20 patients (60%) had postoperative extraocular muscle movement restriction, and 15 of 20 patients (75%) had epiphora. Subsequent revision procedures were needed in 12 of 20 patients (60%), including insertion of a lacrimal bypass tube and revision of medial canthal position. At a mean follow-up of 38 months, 18 of 20 patients (90%) were still alive (2 deaths due to other causes) with 1 recurrence (exenterated). Postoperative visual acuity was within 2 Snellen lines of preoperative visual acuity in 17 of 20 patients (85%).
With careful planning and margin control, conservative surgery in this highly selected group proved possible with a low rate of disease recurrence, albeit with a relatively short follow-up. Postoperative complications, such as epiphora and ophthalmoplegia, were largely expected; most patients underwent subsequent revision procedures to address these and other complications.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
描述一组内侧眼角基底细胞癌（BCC）侵犯前眶患者的病例系列，这些患者采用非眼眶内容剜除术进行治疗。
国际、多中心、回顾性、非对照、连续病例系列。
从各个机构的数据库中确定了 20 名经组织学证实为眼周 BCC 侵犯眼眶的患者。
检查图表、相关影像学和组织病理学数据。
人口统计学资料；临床特征和影像学特征；组织病理学特征；切除、重建和后续手术的外科技术；并发症；视力；和复发。
共确定了 20 名患者。20 名患者中有 12 名（60%）为复发性 BCC，其中 1 名患者曾因先前不完全切除而行过放射治疗。20 名患者中有 18 名（90%）有可触及的肿块，16 名（80%）有鼻泪管系统的临床受累，1 名（5%）有有限的眼球运动。20 名患者中有 10 名（50%）术前影像学证据显示眼眶侵犯。20 名患者中均有组织学证据显示眼眶侵犯，亚型为浸润性（9/20，45%）、结节性（4/20，20%）、微结节性（2/20，10%）、多灶性（1/20，5%）和混合性（4/20，20%）；1 名患者（5%）存在肿瘤外神经周围侵犯。20 名患者中有 18 名（90%）最终切缘为阴性，1 名（5%）阳性，1 名（5%）未明确。1 名患者采用直接闭合重建，19 名（95%）患者采用各种标准眼整形皮瓣和移植物重建。20 名患者中有 12 名（60%）术后出现眼外肌运动受限，15 名（75%）出现溢泪。20 名患者中有 12 名（60%）需要进行后续的修正手术，包括植入泪道旁路管和修正内眦位置。在平均 38 个月的随访中，20 名患者中有 18 名（90%）仍然存活（2 例因其他原因死亡），1 例复发（行眼眶内容剜除术）。术后视力在 20 名患者中有 17 名（85%）与术前视力相差 2 个 Snellen 线以内。
在这一高度选择的患者群体中，通过仔细的规划和切缘控制，保守手术是可行的，疾病复发率较低，但随访时间相对较短。术后并发症，如溢泪和眼肌麻痹，是可以预期的；大多数患者需要进行后续的修正手术来解决这些并发症和其他并发症。
作者在本文讨论的任何材料中均没有专有的或商业的利益。
